A STUDY conducted at Mayo Clinic, Arizona, USA, demonstrated the benefits of refining stool testing practices to improve diagnostic and antimicrobial stewardship for Clostridioides difficile. By removing C. difficile from a gastrointestinal pathogen panel (GIPP), researchers achieved a significant reduction in unnecessary testing and treatment without compromising patient care.
The quasi-experimental study, spanning from January 2022–January 2024, analysed outcomes before and after the intervention. Baseline data revealed that 2,772 GIPPs were ordered for 2,307 unique patients, averaging seven tests per day. C. difficile was the most frequently detected target, identified in 51% of positive results. However, nearly all detected cases (94.9%) led to treatment, raising concerns about overtreatment of colonisation rather than infection.
In the post-intervention period, GIPP orders decreased significantly from 3.23 to 2.7 per 1,000 patient visits (P<0.001). Targeted testing using glutamate dehydrogenase and toxin antigen immunoassay, supplemented by toxin gene testing for discrepant results, ensured accurate diagnosis. Notably, prescribing of C. difficile treatments declined across inpatient and outpatient settings, reflecting improved stewardship. Importantly, no cases of delayed C. difficile diagnosis were reported during this period.
Surveys conducted with providers and nurses revealed knowledge gaps and varying testing practices, stressing the need for education on appropriate C. difficile testing.
This intervention highlights the value of aligning testing practices with clinical needs. By refining diagnostic approaches, the authors managed to reduce unnecessary treatment while ensuring timely and accurate C. difficile diagnoses. Overall, the findings support targeted testing as a means to curb overuse of broad panels, enhancing antimicrobial stewardship, which is currently a critical priority in healthcare settings.
Ada Enesco, EMJ
Reference
Ilges D et al. Positive impact of a diagnostic stewardship intervention on syndromic panel ordering practices and inappropriate C. difficile treatment. Infect Control Hosp Epidemiol. 2024;DOI:10.1017/ice.2024.180.
